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The Senior Network Optimization Professional oversees various efforts involving provider network processes and governance to support state specific network adequacy requirements. The Senior Network Optimization Professional works assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Description

The Senior Network Optimization Professional drives network optimization and value through managing network contracting governance, process development, and data governance for Ohio Medicaid, including contracting requirements and data integrity as required in the Ohio Medicaid Provider Agreement and internal reporting compliance. This role will support network optimization and governance through the development of governance tools, processes, and polices for the OH Medicaid Network Optimization team. This role will work closely with internal partners to facilitate the creation of reporting and tools needed to meet regulatory requirements and to transition from an adequate to a fully optimized network.

Responsibilities

• Drives network optimization and value through network contracting governance, process development, and data governance Ohio Medicaid, including developing contracting requirements, internal reporting compliance processes and supporting data integrity as required in the Ohio Medicaid Provider Agreement.
• Supports network optimization and governance through the development of governance tools, processes, and polices for the Humana Healthy Horizons Ohio Network Optimization team.
• Works closely with internal partners to facilitate the creation of reporting and tools needed to meet regulatory requirements and to transition from an adequate to a fully optimized network.
• This role will report to a Network Optimization Lead

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s Degree or Equivalent Experience
• 3+ years of provider data management experience
• 2+ years of process creation or improvement experience
• Strong knowledge of provider network operations tools, processes, and best practices
• Ability to quickly learn new systems and processes
• Ability to manage and prioritize multiple projects or priorities
• Proficiency at achieving results within a highly matrixed organization
• Proficient in SQL
• Proficient in MS Office Applications including Teams, MS Word, PowerPoint, Outlook, and Excel
• Excellent written and verbal communication skills

Preferred Qualifications

• Experience in Network Adequacy
• Strong familiarity with Medicaid, Ohio Medicaid, and/or Ohio Medicaid NextGen program to actively advocate for Network Optimization’s network priorities with internal stakeholders and shared services
• Proficiency in Microsoft Access and Sharepoint
• Proficiency in PowerBI

Interview:

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

WAH:

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job r